The Fifth Social Security Code regulates the so-called reimbursement of costs for people with statutory health insurance in private practices (Section 13 (5) SGBV). This is intended to counteract the fact that people with mental illnesses often have to wait months for a place in therapy. The statutory health insurance funds have a mandate to guarantee comprehensive, needs-based care for their policyholders close to where they live. If this target is not met (e.g. if the waiting time for an appointment is unreasonable: usually more than 3 months), the statutory health insurance fund must cover the entire costs of private medical treatment upon application, provided that this treatment is provided promptly and with the same qualifications as a doctor or therapist licensed by the health insurance fund (license to practice medicine, specialist certificate, entry in the medical register, etc.).

To ensure that the insured person's application for reimbursement of costs is approved, the Federal Chamber of Psychotherapists provides important information that patients should pay attention to in advance.

Below you will find the 5 steps for the cost reimbursement procedure. Please read everything carefully. At the bottom you will find the necessary forms for download.

1

Try to get an appointment with a therapist approved to bill statutory health insurance providers

• The first step is to call several statutory health insurance-approved therapists near your home and try to get a therapy appointment as soon as possible. A list of health insurance-approved therapists can be found at the Association of Statutory Health Insurance Physicians in Bavaria. If you get an appointment as soon as possible, make use of it.

• Otherwise, and here starts the procedure, document the date and time of your request, the name and address of the therapist and when you were promised an appointment. You can download a template for your documentation below.

• In addition, you should at least make two appointments via the so-called appointment service center (Phone: 116 117) in a psychotherapeutic consultation with a therapist approved by the health insurance. Ask for the PTV11 form. Since April 1, 2017, all health insurance-approved therapists are obliged to offer a weekly consultation hour to which you can come without making an appointment in advance. Please also document this visit and the result of your efforts.

2

Contact my practice

• If you have been unsuccessful in finding a therapy appointment, please contact me.

• If you have not received an appointment from at least 5 therapists approved by statutory health insurance companies, if you have had to wait more than three months for an appointment or if there is an acute urgency for treatment and your health insurance company has not been able to find you a therapy place, make an appointment with me and bring the documentation of your unsuccessful appointments with you.

3

Come and see me for an initial consultation

• Get to know me.

• During this consultation, the need for psychotherapeutic treatment will be determined. If this is the case, you will receive confirmation from me that your treatment is medically necessary and can be carried out by me at short notice as a licensed psychological psychotherapist registered in the medical register.

• You will also need a certificate of urgency from your family doctor or a psychiatrist. Download the relevant form at the bottom of this page. Use this form to present yourself to your family doctor or a specialist: they will check that there are no physical illnesses that would prevent you from undergoing psychotherapy (this is required before any psychotherapy is started). Ask your doctor to complete the certificate of urgency.

4

Submit all documents to your health insurance company

• Send all documents (1. your application with your documentation, 2. my certificate of necessity, 3. medical consultation report) promptly by registered mail to your health insurance company. You must always submit the application yourself before starting psychotherapy.

• You have the right to receive a decision from your health insurance company within 3 weeks of receipt; if an assessment procedure is necessary, the deadline is extended to 5 weeks. If this period expires without a decision, the therapy is deemed to have been approved.

5

Benefit from your therapy in my private practice

• Once you have overcome the bureaucratic hurdles, you can concentrate on the therapy in my practice and benefit from the treatment.

• You can wait to start until you have received a positive written decision from your health insurance company or you can start your sessions before then. However, the costs will only be covered if you receive a positive decision from your health insurance company; if an application is rejected, you as the insured person have the right to appeal.

• You will receive a monthly invoice from me, which you should transfer to me within the specified period. You submit this invoice to your health insurance company and have the costs reimbursed to your account (“cost reimbursement”). This means that I will not bill you directly via your insurance card, as you are used to, but directly with you as the contractual partner.

• The therapy you procure yourself is a private treatment, i.e. your health insurance company is not allowed to reduce the services to the statutory health insurance rate, but must pay the private medical rate. Nevertheless, it is often common practice for invoices to be reduced to the statutory rate, leaving a deductible. Here, too, you can lodge an objection.